 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Steven Fleming, PhD, Health Services, University of Kentucky, 121 Washington Avenue, Lexington, KY 40536, (859) 323-5059 Ext 279, stflem2@uky.edu, Holly E. Pursley, MD, MSPH, Internal Medicine, University of Kentucky, K518 Kentucky Clinic, Lexington, KY 40536, Beth Newman, PhD, Centre for Public Health Research, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia, Dmitri Pavlov, PhD, Biostatistics & Reporting, Pfizer, Inc, 50 Pequot Avenue, New London, CT 06320, and Kun Chen, PhD, Biometrics Department, Bayer Corporation, 400 Morgan Lane, West Haven, CT 06516.
Purpose: The purpose of this research was to determine whether comorbidities affect the stage at which breast cancer is diagnosed. Study design: Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) was merged with Medicare claims for 17,468 women diagnosed with breast cancer from 1993-1995. Results: Women with cardiovascular disease, musculoskeletal disorders, mild to moderate gastrointestinal disease, and nonmalignant benign breast disease had a 14%, 8%,16%, and 25% lower odds, respectively, of being diagnosed with advanced breast cancer. Women with diabetes, other endocrine disorders, psychiatric disorders, or hematologic disorders increased the odds of a late-stage diagnosis by 18%, 11%, 23%, and 20% respectively. Both aggregate measures of comorbidity burden increased the odds of late-stage diagnosis. Mammography screening and contact with the medical care system decreased the odds of late-stage diagnosis. Discussion: Four hypotheses are suggested to explain this link between comorbid illness and stage at diagnosis. The surveillance hypothesis is supported by those comorbidities that increase the odds of a late stage diagnosis. The pathological, “competing demand,” and “death from other causes” hypotheses are supported by those comorbidities that increase the odds of a late-stage diagnosis. Conclusions: Clinicians need to be aware that comorbidities may complicate the diagnostic decision-making process for breast cancer. The results suggest that contact with the medical care system improves the odds of early-stage diagnosis. Thus, barriers to access for people with chronic conditions may exacerbate those chronic conditions and increase the odds of late-stage breast cancer.
Learning Objectives:
Keywords: Breast Cancer, Co-morbid
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.